BY MELANIE A. PRINCE, RN, BSN, MSN, NE-BC, CCM, FCM, FAAN
This issue of CMSA Today is a compilation of articles, editorials and resources about legal considerations in healthcare. I recently attended a Health Equity Summit with leaders from a variety of sectors, including law, government, healthcare, academia, public health and community advocacy. These professionals coalesced at the intersection of health equity and their specific careers. One of the segments focused on how laws and the ethical ethos of justice contribute to population health. Consider the link between social factors and health. We know social determinants of health contribute to the well-being of an individual or population. Gomez, et.al., (2021) documented two decades of research and contributions that support how “conditions in the environments in which people are born, live, learn, work, play, worship and age—the social determinants of health—influence a wide range of health and well-being outcomes, functioning and quality-of-life outcomes and risks.” But what is a dominant contributor to these environmental conditions and social factors? Federal and state laws form national and local policies that shape societal factors within people’s environments. Indeed, a strong case can be made for the inherent links between law, social factors and health.
In fact, Teitelbaum, et.al., (2019) posit that the law is a critical determinant of health. They describe several examples to highlight how laws contribute to the health of a population. A few of these examples are:
- Laws that govern programs such as Medicaid, Medicare, the Public Health Service Act, the Affordable Care Act, the Women, Infants, and Children Supplemental Nutrition Program and the Ryan White HIV/AIDS program.
- Laws that govern social environments such as immunizations, motor-vehicle safety, workplace safety, infectious disease control, drinking water fluoridation, tobacco control and food safety.
- Laws that govern the social determinants of health such as housing, education, labor, lending practices, transportation and criminal justice policies (Teitelbaum, et.al., 2019).
As case managers, we understand the tension between federal/state laws and advocacy for vulnerable populations who may be challenged with equal opportunity to seek and maintain care in a complex healthcare system. Federal and state laws create the environment, systems and infrastructure in which we care for patients. Laws impact and influence healthcare decisions, which ultimately affect patient/client outcomes. Teitelbaum, et.al., (2019) remind us that the negative consequences of social determinants of health can be the result of laws, but laws can also be the remedy to address social determinants of health. It is the remediation role of law that inspires my belief in the power of medical-legal partnerships to drive outcomes in population health. The expertise of lawyers and legal scholars can exponentially contribute to comprehensive solutions of access, equity and safety in healthcare. Imagine programs and processes for transitions of care, designed by a medical-legal team of professionals.
Case managers are leading the way in care management, policy formulation, clinical educational, development of standards and professional advancement. A medical-legal partnership will ensure patient/client experiences are enhanced across the spectrum of care. Medical-legal collaborations will drive solutions for health equity and population health. Case management practice is enhanced with the inclusion of legal perspectives. This issue is a must-read!
Gómez, C., Kleinman, D., Pronk, N., Wrenn-Gordon, G., Ochiai, E., Blakey, C., Johnson, A., Brewer, K. (2021). Addressing health equity and social determinants of health through healthy people 2030. Journal of Public Health Management and Practice, 27(6_suppl), 249-S257. https://doi.org/10.1097/PHH.0000000000001297.
Teitelbaum, J., Theiss, J., & Boufides, C. (2019). Striving for health equity through medical, public Health, and legal collaboration. The Journal of Law, Medicine & Ethics, 47(2_suppl), 104–107. https://doi.org/10.1177/1073110519857330.
Melanie A. Prince, RN, BSN, MSN, NE-BC, CCM, FCM, FAAN, is the immediate past president of Case Management Society of America (CMSA), 2020 – 2022. She is a retired active-duty military colonel who was assigned to Headquarters Air Force, where she was responsible for developing strategies to eliminate interpersonal violence in the military. Melanie is now the chief executive officer, Care Associates Consulting and MAPyourWAY, LLC. A distinguished leader and mentor in her profession, she has won numerous awards, including the distinguished CMSA Chapter2003 and National Case Manager of the Year 2004. Melanie is a CMSA Case Management Fellow (FCM) and Fellow American Academy of Nursing (FAAN).